Age-related physiologic changes and perioperative management of elderly patients

Aging itself only minimally increases operative risk, but with aging, there is an increase of the prevalence of chronic diseases and a progressive deterioration of organ function. Aging is associated with a progressive decrease in heart, lung and kidney performance. Under normal conditions, these physiologic changes do not produce any problems for the elderly, but when these patients are subjected to the stress of surgery or its complications, there may be inadequate functional reserve. It is very important to know age-related patho-physiological changes in order to be able to better evaluate elderly patients undergoing surgery, and to prevent and manage preoperative complications. In this review we try to identify and to describe the most frequent physiological changes in the elderly, how those impact pharmacodynamic and pharmacokinetic parameters, and how to assess and manage them.